Insurer Held Accountable for Misleading Explanation of Policy to Elderly Traveller
Insurer Held Accountable for Misleading Explanation of Policy to Elderly Traveller
The information on this website is general in nature and does not take into account your objectives, financial situation, or needs. Consider seeking personal advice from a licensed adviser before acting on any information.
An elderly gentleman, who submitted a claim on behalf of his injured wife, has successfully resolved his dispute against his insurance company.
The Australian Financial Complaints Authority ruled in favor of the complainant, finding that he had been misled into thinking he had coverage.
The claim was initiated after the man's wife had a severe fall down a flight of stairs during their trip to Thailand. She sustained multiple injuries, including a fractured hip and head trauma, which required her to be hospitalized for more than three weeks. Additionally, to ensure a safe journey back to Melbourne, the claimant had to purchase a business class flight for his wife, allowing her to lie flat and minimize the risk of complications.
Zurich Australia denied the claim based on the policy's exclusion of overseas medical expenses for individuals over 80 years old. However, Zurich claimed to have offered an "upgrade" to the policy, providing medical coverage for individuals over 80, which the claimant did not opt for.
The complainant obtained the policy through a local branch of his bank, referred to as CB, which offered it as a benefit for specific credit card holders. At the time of purchasing the policy, both the complainant and his wife were 81 and 80 years old, respectively.
Making an effort to follow the correct procedure given his limited computer skills, Mr. E visited the local CB branch on June 30. He expected the staff to guide him through the application process for the policy.
Mr. E alleged that the CB staff failed to inform him about the need to "upgrade" the policy in order to ensure adequate coverage for medical expenses. He left the bank under the impression that he and his wife were appropriately insured, even receiving an email confirmation from the insurer stating that the policy had been activated.
AFCA considered the claimant's assertion that a bank teller, referred to as SH, had assisted him during the application process. Despite Zurich's objections, the ruling ombudsman agreed with Mr. E's account.
The ruling acknowledged that SH had neglected to disclose the requirement to "upgrade" the policy, necessary for the claimant and his wife to have coverage, despite the bank being aware of their age. It stated that although SH's actions were unintentional, CB caused the insured party to believe they had suitable coverage.
"Given CB's knowledge of the complainants' age, this omission should have been disclosed," AFCA stated.
"SH's oversight significantly contributed to Mr. E's unwitting failure to apply for the policy upgrade. Furthermore, this omission induced Mr. E to enter into an insurance contract that he believed provided adequate coverage. However, unbeknownst to him, the policy was essentially useless in terms of overseas medical expense coverage for both him and Mrs. E."
Zurich argued that CB employees were not authorized representatives and thus were unable to offer any advice on the credit card insurance being offered. However, AFCA dismissed this argument as an attempt by the insurer to absolve itself of CB's shortcomings, stating that the bank acted, at least partially, in the insurer's interest.
The decision mandates that Zurich accept the claim and provides a compensation of $4000 ($2000 for each complainant) for non-financial losses resulting from the insurer's claim denial and subsequent challenges.
"Throughout the claims process, the insurer's stance has unfortunately caused the complainants, particularly Mr. E, to feel accused of dishonesty," expressed AFCA.
"They also feel that their recollections have been questioned. Moreover, the insurer's position in this claim has been based on flimsy evidence."
Please Note: We do not endorse any specific products or companies. Some content is sourced from third parties, including press releases, and may not be independently verified for accuracy or completeness.
Recent transport and fleet industry coverage continues to point to a steady increase in electric and low-emission heavy vehicles across Australian logistics operations. For many operators, the attraction is clear: quieter vehicles, lower tailpipe emissions, potential fuel savings and stronger alignment with customer sustainability targets. But the insurance conversation is now becoming more detailed than simply replacing a diesel truck with an electric one. - read more
APRA’s latest quarterly general insurance statistics point to a market that is still under cost pressure, even as insurers continue to report stronger overall results than during the worst of the recent claims cycle. For Australian tradespeople, the headline is not simply whether insurers are profitable. The practical issue is how rising premiums, repair costs, reinsurance expenses and claims activity flow through to the price and availability of cover used every day on the tools. - read more
Australia’s financial advice reform agenda has taken another important step, with industry attention turning to how simpler, more accessible guidance could help consumers make better decisions about insurance. For workers who rely on income insurance or salary continuance cover, the issue is more practical than political: many people hold cover they do not fully understand until illness or injury forces them to test it. - read more
Recent transport and insurance industry attention on lithium-ion battery safety is a timely warning for Australian truck operators. The issue is no longer limited to consumer products catching fire in homes or warehouses. Batteries now move through freight networks in tools, scooters, e-bikes, electronics, spare parts and energy storage equipment, and that creates a different risk profile for carriers, depots and subcontracted linehaul work. - read more
Australia’s latest seasonal bushfire outlook is a practical reminder that fire risk is not confined to the height of summer. For many farms, the exposure begins well before a catastrophic fire day is declared, as grass growth, drying winds, stored fodder, machinery movement and access limitations combine to create a more complex risk profile than a standard rural home policy can address. - read more
Life insurance is a crucial consideration for middle-aged to older Australians. It provides financial security for your loved ones in the unfortunate event of your death. Understanding the various options available is vital to making an informed decision. - read more
TPD insurance can provide a lump sum if you become totally and permanently disabled and meet your policy's definition. Learn how TPD cover works in Australia, how it relates to life insurance, and what to compare before applying. - read more
The horizon of the insurance industry has undergone a transformative shift with the advent of digital technology. With a few clicks, consumers can navigate the once-complex world of insurance policies from the comfort of their home. The digital landscape for insurance services offers unprecedented access to information, comparisons, and instant communication, fostering a more empowered insurance client. - read more
As the landscape of finance and personal security evolves in Australia, the importance of being insured has never been more prominent. In a world of changing family dynamics, economic pressures, and higher living costs, life insurance stands as a bastion of support ensuring the well-being of loved ones in the event of unforeseen circumstances. - read more
The financial fabric of our lives consists of both planning and safeguarding against the unforeseen. Trauma cover, a lesser-known but crucial aspect of personal insurance, provides this protection by offering a lump sum payment upon diagnosis of specific serious illnesses or injuries. In the tapestry of financial planning, it acts as a vital safety net, ensuring that unexpected health crises do not lead to monetary distress. - read more
Start Here !
Apply now for your free Insurance assessment and price comparisons!
Knowledgebase
Incontestability Clause: A provision in a life insurance policy that prevents the insurer from voiding coverage due to a misstatement by the insured after a certain period.
No comments yet. Be the first to share your thoughts.